Visually Self-induced Seizures Sensitive to Round Objects

Summary: Purpose: To describe a previously unreported type of self-induced pattern-sensitive seizures in a child.

Methods: Evaluation of clinical and EEG features.

Results: An 18-month-old boy was initially seen with series of short focal tonic seizures self-induced by gazing intermittently at round objects. Self-induction of these seizures had an obvious relieving effect on the child. Covering the round object foiled further seizures but resulted in a tantrum. Later in the course, an increasing variety of patterns proved to be capable of inducing seizures, which occurred with increasing frequency and severity, including secondarily generalized tonic–clonic seizures. Interictal EEG revealed multifocal sharp-and-slow-waves. Ictal EEG showed no abnormalities during short focal seizures and rapidly generalizing epileptic discharges during a secondarily generalized seizure. No photosensitivity was noted. Motor and mental development of the boy stagnated over a period of 2 years. Behavioral therapy as well as medical treatment, consisting of various combinations of antiepileptic drugs (AEDs) together with a selective serotonin-reuptake inhibitor, were of merely transient benefit. Only combined pharmacotherapy, including valproate, sulthiame, and clobazam, resulted in seizure control at age 3 years 9 months.

Conclusions: Visual capture of geometric patterns other than stripes or gratings may trigger focal seizures with secondary generalization. Synchronization of cortical neurons responsible for pattern recognition may account for epileptogenesis in this child.